Healthcare Provider Details

I. General information

NPI: 1730469628
Provider Name (Legal Business Name): MICHELLE MARIE HOMMERT-HELM MSW, CADC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE ROTTER MSW, CADC

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SKOKIE BLVD STE 218
NORTHBROOK IL
60062-4043
US

IV. Provider business mailing address

121 S MAIN ST
GLEN CARBON IL
62034-1418
US

V. Phone/Fax

Practice location:
  • Phone: 847-668-4295
  • Fax: 847-668-4295
Mailing address:
  • Phone: 618-520-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: